Provider Demographics
NPI:1770871741
Name:HIGGINS, JOE W JR
Entity type:Individual
Prefix:MR
First Name:JOE
Middle Name:W
Last Name:HIGGINS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 BRIXTON RDG
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-1620
Mailing Address - Country:US
Mailing Address - Phone:256-230-5218
Mailing Address - Fax:615-597-1112
Practice Address - Street 1:516 W MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:SMITHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37166-1142
Practice Address - Country:US
Practice Address - Phone:615-597-7822
Practice Address - Fax:615-597-1112
Is Sole Proprietor?:No
Enumeration Date:2011-07-12
Last Update Date:2021-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3922183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1170871741Medicaid